Childhood trauma brings its own health problems for foster families

Foster kids are six times as likely as other children to have behavioral problems, according to a study published in the journal Pediatrics. (Sonia Pulido for The Washington Post)

ByJenny Rough

September 1

“Raise your hand if you think every child deserves a loving home,” the social worker said.

She held up a photo of five brothers and sisters, all teenagers.

I glanced around the room and tried to read the eyes of other potential foster-care parents at the information session. A dozen couples and a handful of singles ranging in age from late 20s to mid-50s sat in the conference room of a private nonprofit agency in Maryland that handles foster placements. Did they feel as uncertain as I did?

People often say they can’t be a foster parent because it would be too painful to grow close to a child only to say goodbye. But with more than 430,000 kids in foster care in the United States and a decline in the number of available beds in licensed foster homes, according to the Chronicle of Social Change, I wondered whether the real reason for the shortage of foster parents stems from the unspoken fear I harbored: concern about the health and behavioral challenges of kids who had experienced trauma.

Not only do kids suffer trauma from the circumstances that led to foster care in the first place, but they also experience the grief of being separated from their primary attachment, says Chrissy Levine, a social worker with the Department of Community and Human Services in Alexandria, Va.

“Even when the abuse and neglect is bad, that’s what their normal looks like, so when you take them away from their primary attachment, that to them is the most traumatic thing,” she says.

The back-and-forth system of reuniting families, separating them again or moving among foster homes further traumatizes the children, adds Anne Moody. In her book “The Children Money Can Buy,” she chronicles her observations of the foster and adoption system based on her career as a social worker and adoption counselor.

Neither the abuse nor the number of different placements is the child’s fault. Kids often flourish when placed “in a committed, nurturing home that keeps them connected to their birth families,” Levine says. But it doesn’t change the fact that caring for a child who has been through severe trauma can be intimidating.

Foster kids are six times as likely as other children to have behavioral problems, according to a study published in the journal Pediatrics.

The types of issues will “range all over the place, depending on the kid and what happened to them previously,” says Nathan Fox, director of the Child Development Laboratory at the University of Maryland. Some kids show anxiety and depression. Others might be openly uncooperative or physically aggressive. Many struggle with impulse control.

“Kids who experience abuse or neglect have behavioral problems which are ultimately associated with the development of psychiatric problems,” Fox says.

“They will be continually worried not only about themselves but about their parents and siblings. And they will be exhausted from all this emotion,” Moody adds.

Research conducted by Harvard Medical School, the University of Michigan and Casey Family Programs found that former foster kids developed ­post-traumatic stress disorder at almost twice the rate of combat veterans. And research by Bruce Perry, a senior fellow of the ChildTrauma Academy in Houston, has shown that a chaotic childhood or abusive caregiving can disrupt brain development in multiple and complex ways.

“These abnormalities in brain development may result in a persisting or abnormally over-reactive flight-or-flight response that can include attention problems, and oppositional and defiant behaviors,” he says. Or the child may develop a dissociative response that can contribute to detachment and withdrawal.

Physical health problems, including cardiovascular disease and diabetes, have also been linked to children who experience early abuse, says Fox, “but it takes longer for the physical health consequences to emerge.”

The information meeting I attended in Maryland occurred nine years ago. I was 35 and had assumed I’d be a mom. But I developed endometriosis. Treatment didn’t help, so when my husband and I saw an announcement about foster care on a fertility association’s website, we decided to check it out. If motherhood wasn’t in my future, I wanted to at least explore mothering-type roles.

“Teens and sibling groups,” the social worker holding the photo of five said. “That’s our biggest need.”

I gave my husband big eyes to see if he thought this whole idea was crazy. He didn’t. Nothing scared him — not even unruly teenagers.

“Fostering teenagers can be challenging,” the social worker continued. “They’ll test boundaries. For example, they might steal your car in the middle of the night.”

I felt uneasy — until I remembered I’d done the same thing to my parents as a teenager.

“Younger kids will act out, too,” she said. “Recently, a couple took in a 7-year-old. She set the bathroom rug on fire.”

Fire? As in combustion, smoke and flames? That sounded bad. Then again, my brother set the backyard trees on fire when he was 8.

“It’s not unheard of for a foster child to falsely accuse a foster parent of sexual abuse,” the social worker continued. “Child Protective Services may be required by law to open a case against you if that happens. Try not to let it rattle you.”

By the end of the meeting, I sprinted to the parking lot.

The social worker hadn’t minced words. She wanted prospective foster parents to understand the challenges of living with a traumatized child. “The last thing [child welfare] workers want is to place children with families who didn’t understand what they were taking on,” Moody says. Many people will self-select out of the process.

On the one hand, misbehavior by a foster child might simply be a kid being a kid, or normal teenage rebellion. When biological children act out, it’s handled within the family. But when it happens with foster kids, it’s a different story.

“Because of the stigma, these kids make a bad decision and the foster parent says, ‘I can’t handle this; they need to leave my home,’ ” Levine says.

On the other hand, behavioral problems with foster kids often aren’t the same as with those who were raised in nurturing environments. “It’s not behavior that happens once or twice. It’s chronic behavior that puts themselves and other people in danger,” Fox says.

One key in addressing the health and behavioral issues, in addition to providing a stable, nurturing environment for as long as possible, is to understand the root cause of the behavior, Levine says.

“Sensory issues can look like defiance, but it’s not. A kid might act out because they’re missing their mom or dad. A phone call with Mom or Dad can help a kid cope with regulating their big feelings,” Levine says. “Foster parents can educate themselves on positive discipline techniques that address the behavior and the root cause.”

The social worker assured us we would develop a real relationship with a child and that the size of a problem on paper can look more challenging than it actually is. Still, I was wary about taking on foster kids and didn’t feel equipped to handle it.

Over time, my life didn’t feel empty from a lack of children or child-care responsibilities. It felt full with meaningful relationships and work I loved. Yet my thoughts occasionally returned to foster parenting, especially when I heard news stories about babies being born hooked on heroin or of children who were taken from parents who abandoned or neglected them. The reports kept bringing my attention to the crisis in our country.

A lawyer friend of mine once said that when he learned of the plight of incarcerated youth, he thought: “Somebody needs to do something about this problem. It’s not going to be me.” Until one day he realized, yes, it was. Today, his work focuses on improving the criminal justice system for young people.

Serita Cox, founder of iFoster, a nationwide online community of 45,000 members that provides resources to children in foster care, dedicates her life to helping foster families. Cox says she has witnessed tremendous improvements in the behavior of foster kids when they receive opportunities that other kids normally have, such as the chance to take guitar lessons or attend summer camp. iFoster partners with Microsoft to provide foster kids with laptops, works with a nonprofit group called Smiles Change Lives so kids can get braces for their teeth, and arranges scholarships for after-school activities such as gymnastics and equine therapy.

“Kids need to feel loved, they need to feel safe and supported, and they need the stuff that other kids get the opportunity to do, like get glasses or go to the movies,” Cox says.

There is a big debate about how to best handle kids who have been cared for inappropriately. Ideally, “we would pour resources into helping families who are in danger of separation due to factors such as homelessness, substance abuse, mental-health concerns or poverty before the children are removed from the home instead of after,” Moody says. Yet ultimately, as she concludes in her book, “the real world is full of children who need to be safe and loved right now, and they should not be asked to put their lives on hold while we wait for a perfect world.”

Moody’s book turned out to be the game-changer for me. It opened my eyes to the hard truths of foster care without making me despair. After I read it, I walked away with an important understanding: Being a foster parent is hard, but being a foster child is much harder.

This past spring, my husband and I signed up for foster-care training. In class, we learned about all sorts of difficult situations we might face: how to handle a repeat runaway; what to do if an 11-year-old girl acts out by having sex with boys from school; what to do if a child, removed from a home because of a hoarding situation, brings in bed bugs.

I don’t yet have all the answers, but I do have some: If you can’t talk the child out of leaving, let the runaway go, then call 911; address the safety and ­self-esteem issues of early sex with the child’s social worker and therapist; bug control is a phone call away. I’m gaining confidence I’ll learn what I need to learn. Receiving proper training helps, foster parent support groups exist, and iFoster has a hotline. Still, there are times in class when I hear about behavioral issues and the fear creeps back.

“Lock up your prized possessions,” the social worker once warned.

Those are the moments I glance at the door. My running shoes are on my feet. And I wonder whether the most difficult decision isn’t going to be anything like how to handle a teenager who wets the bed or a 9-year-old who slashes furniture with a knife. The most difficult decision is the one I face right then: the decision to stay.

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